[orthodoc]

She told her father tonight. He told her it was a great idea, great plan, although he had some sudden irritation at the corners of his eyes that required rubbing and left his eyes suspiciously shiny.

She couldn't/wouldn't give me the address of the gf she says she'll stay with, and then said she's going to use a PO Box. Because she and her gf will be moving again in a few months when the lease ends and it's so tiresome to be having mail forwarded multiple times. All very plausible except that she routinely lies to us. She's not going to live with her gf, she's going to live with the guy she's infatuated with.

It's not that she thinks I'm completely stupid; she just desires to avoid awkward conversations at all cost. She doesn't want to hear anything that she doesn't want to hear.

Her father will take her to the airport Thursday morning on the same trip he makes to pick up my BFF from grade school, who is flying here from Ontario to visit for a few days.

Her geographic removal is just the logical sequel of her psychological removal. That happened in 2012 when she left school without saying a word. Somehow, this removal is just as painful as that one. I suppose I'd harbored hope that she'd follow through on her declared agenda while here.

It's her life. She'll do what she needs to do, make the best decisions that she sees at the time, and live with the result. Watching a child choose a train wreck is something I ought to have some expertise in by now, ought to have reached some equanimity in the situation. See the setup, watch the wreck coming, go in with the EMS, and provide tertiary damage mitigation. As Dylan Thomas said, home is the place where, when you go there, they have to take you in. They keep their grief to themselves.

Oh, and I'm about to have my first lawsuit, over something that happened while I was in DC at my board review course. I'll be part of it because I was involved before and after coming back. I did everything and busted my ass to get care for the individual, but the outcome will be sub-optimal. While that would probably have been the case no matter what, a less-than-perfect outcome always means a lawsuit. Merkins have a constitutional right to a perfect outcome.

I have worked hard for this individual, made interim arrangements for assessment while I was away, researched the injury and treatment options, been in frequent contact by phone, provided careful and comprehensive pain management, and given out my cell number in case of concerns. On the day of injury I referred the individual to a specialist due to the extent and complexity of the injury. But my colleague missed a critical decision point while I was away, and now the outcome will not be perfect.

The sub-specialist who should have been contacted by my colleague has told the patient that his expertise would have saved the situation, even though the literature doesn't support his claim. I will go head to head with this guy on the stand, if it gets that far.

One way or another, I'll lose. Merkins do not suffer permanent sequelae from injuries and not get handsomely compensated. And - I don't begrudge this individual something reasonable. But I don't believe my professional expertise and clinical ability should be derided. I gave this individual the best possible care, carefully and with caring.

I'll be published nationally as a defective doc when the insurance company settles (I won't have a choice about that). In the next ten years people will wonder why they only ever see nurses or physician assistants, and this is part of the reason.